The data, when combined with census information, can then be used to not only report on the level of staff in each nursing home, but also to report on employee turnover and tenure, which can impact the quality of care delivered.

Therefore, the Centers for Medicare & Medicaid Services has developed a system for facilities to submit staffing and census information — the Payroll-Based Journal (PBJ). This system will allow staffing and census information to be collected on a regular and more frequent basis than it is now. It also will be auditable to ensure accuracy. All long-term care facilities will have access to this system at no cost.

However, there is a challenge: Nursing homes may use temporary staff or contract employees. Nurses who are part of this “pool labor” don’t appear on payroll as employees since facilities pay the pool provider with a single check. Another issue to address is when salaried administrative personnel — for example, a director of nursing — fills in for a direct care nurse on a shift. More guidance is needed and expected to be forthcoming.

CMS has been collecting staffing and census data through the PBJ system on a voluntary basis since Oct. 1. Collection/submission will become mandatory on July 1. Training will be offered on registration and for both voluntary and mandatory submissions.